Bell, Audrey

Applicant Audrey Bell, a security guard who sustained industrial injury to her left shoulder and cervical spine, sought reconsideration of a WCJ's F&O affirming an IMR determination that upheld a UR denial of home health aide assistance (4 hours per day, 7 days per week, for 6 months). Applicant argued the IMR was internally inconsistent because the reviewer acknowledged that 'some home health is reasonable' yet denied the entire request. The Appeals Board noted that the IMR rationale appeared to deny treatment based on the six-month duration being 'excessive' without reassessment, while conceding some home health was reasonable, raising a question whether the determination rested on a plainly erroneous finding of fact. The Board also questioned whether the UR reviewer considered the IW Care Connection Home Assessment referenced in Dr. Samimi's report. The Board granted reconsideration to further review the merits and deferred a final decision pending further consideration of the record.